Blockchain Technology: Applications in Health Care.
01 Sep 2017-Circulation-cardiovascular Quality and Outcomes (Circ Cardiovasc Qual Outcomes)-Vol. 10, Iss: 9
TL;DR: The basics of blockchain are described and current and future applications of this technology within the healthcare industry are illustrated, from maintaining permissions in electronic health records to streamlining claims processing.
Abstract: Blockchain technology has gained substantial attention in recent years with increased interest in several diverse fields, including the healthcare industry. Blockchain offers a secure, distributed database that can operate without a central authority or administrator. Blockchain uses a distributed, peer-to-peer network to make a continuous, growing list of ordered records called blocks to form a digital ledger. Each transaction, represented in a cryptographically signed block, is then automatically validated by the network itself. Blockchain has also garnered interest as a platform to improve the authenticity and transparency of healthcare data through many use cases, from maintaining permissions in electronic health records (EHR) to streamlining claims processing. In this article, we describe the basics of blockchain and illustrate current and future applications of this technology within the healthcare industry.
Bitcoin, a cryptocurrency and payment system first introduced in 2008, is one of the most well-known implementations of blockchain.1 The transfer of digital assets, such as bitcoin, within a blockchain is initiated when a seller or payer submits a transaction (Figure [A]).2 These transactions are broadcasted to every peer connected to the blockchain network where clients, called miners, use a cryptographic algorithm to validate the transaction. This validation solves 2 key problems that previously existed with digital currency exchange: ensuring that the digital asset exists and that it has not already been spent. A transaction is said to be valid if a miner deems it is well formed (the input and output contain only the fields that are defined in the protocol), and the outputs it attempts to transfer exist. Miners are not certified and can be anyone who volunteers to invest their resources. The incentive for miners comes in the form of the bitcoin, which are generated and rewarded to the miners for every block of transactions validated. …
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TL;DR: A comprehensive classification of blockchain-enabled applications across diverse sectors such as supply chain, business, healthcare, IoT, privacy, and data management is presented, and key themes, trends and emerging areas for research are established.
1,310 citations
Cites background from "Blockchain Technology: Applications..."
...Managing patients’ Electronic Healthcare Records (EHRs) is probably the area with the highest potential growth (Liu, 2016; Angraal et al., 2017; Hoy, 2017; Kuo et al., 2017; Baxendale, 2016)....
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06 Feb 2020
TL;DR: A state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms, and evidence-based recommendations for minimizing risk are provided.
Abstract: Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.
743 citations
Cites background from "Blockchain Technology: Applications..."
...In the future, we may also see blockchain used to enable greater interoperability and improve security for health information exchange (HIE).(121,122)...
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TL;DR: There is a need for more research to better understand, characterize and evaluate the utility of blockchain in healthcare, and the state-of-the-art in the development of blockchain applications for healthcare, their limitations and the areas for future research are highlighted.
526 citations
Cites background from "Blockchain Technology: Applications..."
...Proprietary Guardtime [13], MedBlock [64], BlockHIE [48,50]...
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...Guardtime, a company that uses a blockchain-based platform to secure over 1 million patients records in Estonia is cited in other reviews as a popular example of the use of blockchain for the management of EMR [13,15]....
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...[13], they identify some examples of the application of blockchain technology in healthcare....
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...Sustainable Cities and Society [34] Information [35] Neumann Colloquium (NC) [36] IST-Africa Conference [37,44] Journal of the American Medical Informatics Association [16] F1000Research [27,60] IEEE International Conference on Communications (ICC) [39] Circulation: Cardiovascular Quality and Outcomes [13] Computational and Structural Biotechnology Journal [40,54] Trials [41] International Conference on e-Health Networking, Applications and Services (Healthcom) [15,69]...
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...Some companies and research projects, such as Guardtime [13] and MedRec [67] have developed blockchain-based EMR applications....
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TL;DR: In this paper, a comprehensive overview of barriers for adopting blockchain technology to manage sustainable supply chains is provided using technology, organizational, and environmental framework followed by inputs from academics and industry experts and then analyzed using the Decision-Making Trial and Evaluation Laboratory (DEMATEL).
472 citations
TL;DR: In this paper, the authors look at how blockchain technology might facilitate the transition from institution-centric to patient-centric data sharing through five mechanisms: (1) digital access rules, (2) data aggregation, (3) data liquidity, (4) patient identity and (5) data immutability.
Abstract: Interoperability in healthcare has traditionally been focused around data exchange between business entities, for example, different hospital systems. However, there has been a recent push towards patient-driven interoperability, in which health data exchange is patient-mediated and patient-driven. Patient-centered interoperability, however, brings with it new challenges and requirements around security and privacy, technology, incentives, and governance that must be addressed for this type of data sharing to succeed at scale. In this paper, we look at how blockchain technology might facilitate this transition through five mechanisms: (1) digital access rules, (2) data aggregation, (3) data liquidity, (4) patient identity, and (5) data immutability. We then look at barriers to blockchain-enabled patient-driven interoperability, specifically clinical data transaction volume, privacy and security, patient engagement, and incentives. We conclude by noting that while patient-driving interoperability is an exciting trend in healthcare, given these challenges, it remains to be seen whether blockchain can facilitate the transition from institution-centric to patient-centric data sharing.
430 citations
References
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01 Aug 2016
TL;DR: This paper proposes MedRec: a novel, decentralized record management system to handle EMRs, using blockchain technology, and incentivizes medical stakeholders to participate in the network as blockchain “miners”, enabling the emergence of data economics.
Abstract: Years of heavy regulation and bureaucratic inefficiency have slowed innovation for electronic medical records (EMRs). We now face a critical need for such innovation, as personalization and data science prompt patients to engage in the details of their healthcare and restore agency over their medical data. In this paper, we propose MedRec: a novel, decentralized record management system to handle EMRs, using blockchain technology. Our system gives patients a comprehensive, immutable log and easy access to their medical information across providers and treatment sites. Leveraging unique blockchain properties, MedRec manages authentication, confidentiality, accountability and data sharing -- crucial considerations when handling sensitive information. A modular design integrates with providers' existing, local data storage solutions, facilitating interoperability and making our system convenient and adaptable. We incentivize medical stakeholders (researchers, public health authorities, etc.) to participate in the network as blockchain "miners". This provides them with access to aggregate, anonymized data as mining rewards, in return for sustaining and securing the network via Proof of Work. MedRec thus enables the emergence of data economics, supplying big data to empower researchers while engaging patients and providers in the choice to release metadata. The purpose of this short paper is to expose, prior to field tests, a working prototype through which we analyze and discuss our approach.
1,578 citations
"Blockchain Technology: Applications..." refers background in this paper
...This platform offers a decentralized approach to managing permissions, authorization, and data sharing between healthcare systems.(7) The use of blockchain in this application is intended to give patients the ability to have agency over and knowledge of who can access their healthcare data....
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...While the permissions, data storage location, and audit logs are maintained in the blockchain, all healthcare information remains in EHR systems and requires additional software components to enable true interoperability.(7) The MedRec project has been tested as a proof of concept with medication data, and the developers are looking to enhance the project’s scope by adding more data types, data contributors, and users....
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22 Feb 2016
TL;DR: In this article, the authors analyze how fundamental and circumstantial bottlenecks in Bitcoin limit the ability of its current peer-to-peer overlay network to support substantially higher throughputs and lower latencies.
Abstract: The increasing popularity of blockchain-based cryptocurrencies has made scalability a primary and urgent concern. We analyze how fundamental and circumstantial bottlenecks in Bitcoin limit the ability of its current peer-to-peer overlay network to support substantially higher throughputs and lower latencies. Our results suggest that reparameterization of block size and intervals should be viewed only as a first increment toward achieving next-generation, high-load blockchain protocols, and major advances will additionally require a basic rethinking of technical approaches. We offer a structured perspective on the design space for such approaches. Within this perspective, we enumerate and briefly discuss a number of recently proposed protocol ideas and offer several new ideas and open challenges.
831 citations
01 Sep 2016
TL;DR: In this article, the authors present several starting points for blockchain technology in the healthcare industry, including public healthcare management, user-oriented medical research and drug counterfeiting in the pharmaceutical sector, and illustrate possible influences, goals and potentials connected to this disruptive technology.
Abstract: Blockchain technology has shown its considerable adaptability in recent years as a variety of market sectors sought ways of incorporating its abilities into their operations. While so far most of the focus has been on the financial services industry, several projects in other service related areas such as healthcare show this is beginning to change. Numerous starting points for Blockchain technology in the healthcare industry are the focus of this report. With examples for public healthcare management, user-oriented medical research and drug counterfeiting in the pharmaceutical sector, this report aims to illustrate possible influences, goals and potentials connected to this disruptive technology.
819 citations
"Blockchain Technology: Applications..." refers methods in this paper
...One implementation example is Guardtime, a Netherlandbased data security firm, which partnered with the government of Estonia to create a blockchain-based framework to validate patient identities.(6) All citizens were issued a smartcard, which links their EHR data with their blockchain-based identity....
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Patent•
13 May 2015
TL;DR: Healthcare transaction validation systems and methods are presented in this paper, where the corresponding healthcare parameters (e.g., inputs, outputs, clinical evidence, outcomes, etc.) are sent to one or more validation devices.
Abstract: Healthcare transaction validation systems and methods are presented. Healthcare transactions associated with a stakeholder are compiled into a chain of healthcare transaction blocks. The chain can be considered a chronicle of person's healthcare path through life. When a transaction is conducted, the corresponding healthcare parameters (e.g., inputs, outputs, clinical evidence, outcomes, etc.) are sent to one or more validation devices. The devices establish a validity of the transaction and generate a new block via a proof-of-work principle. Once the new block has been calculated it can be appended to the stakeholder's health care blockchain.
331 citations